Hordeolum represents an acute infection of the eyelid glands, classified by anatomic location into external and internal variants. External hordeolum (the classic 'stye') involves infection of the glands of Zeis (modified sebaceous glands) or Moll (apocrine sweat glands) at the base of the eyelashes, presenting as a painful, erythematous papule or pustule pointing toward the eyelid margin. Internal hordeolum involves the meibomian glands within the tarsal plate, presenting as more diffuse eyelid swelling with pointing toward the conjunctival surface or skin.
The dominant pathogen is Staphylococcus aureus (>90% of cases), with smaller proportions involving methicillin-resistant strains (MRSA), Staphylococcus epidermidis, and rarely streptococci. Predisposing factors include blepharitis (chronic eyelid margin inflammation), meibomian gland dysfunction, rosacea, diabetes mellitus, and poor eyelid hygiene with cosmetic use, hand-eye contact, or contact lens wear without proper hygiene.
Clinical course typically progresses from initial pain, tenderness, and redness over 1-2 days to formation of a localized pustule or pointing lesion over 2-4 days, followed by spontaneous drainage and resolution within 1-2 weeks. Differential diagnosis includes chalazion (chronic, non-tender lipogranulomatous inflammation of meibomian gland from blocked duct, distinct entity from acute infection), preseptal cellulitis (more diffuse, involves anterior orbital tissue, requires systemic antibiotics), and rare entities like sebaceous cell carcinoma in chronic recurrent presentations. Treatment emphasizes warm moist compresses 4-6 times daily for 10-15 minutes promoting drainage and pain relief, gentle eyelid massage, eyelid hygiene with diluted baby shampoo or commercial preparations, and topical antibiotic ointment (erythromycin, bacitracin) for select cases. Oral antibiotics are reserved for severe cases, surrounding cellulitis, or immunocompromised patients. Incision and curettage by ophthalmologist is reserved for persistent or large lesions failing conservative treatment.